Cultural Competency Key for HIV’s Healthcare Discrimination Problem

Cultural competency is needed to address the healthcare discrimination and stigma felt by Hispanic folks with HIV, according to the latest Centers for Disease Control & Prevention Morbidity and Mortality Weekly Report (MMWR).

That cultural competency could be key to closing the racial health disparities Hispanic individuals see across all disease states, the report said. Particularly, Hispanic people with HIV see disparities in HIV health outcomes compared to other racial groups, the CDC researchers wrote.

Patient access to HIV treatment is lower for Hispanic people than for White people. Previous studies have revealed lower proportions of Hispanic people getting HIV care, being retained in that care, and being virally suppressed when compared to their White counterparts with HIV.

And although discrimination and social stigma are a problem for people of all races diagnosed as HIV positive, this latest MMWR showed those issues are especially troublesome for the Hispanic community.

Using Medical Monitoring Project (MMP) data from between 2018 and 2020, the researchers looked at self-reported stigma and healthcare discrimination among 2,690 Hispanic people with HIV.

That assessment revealed a median stigma score of 31.7 on a 100-point scale, with women and Hispanic people who also identify as American Indian/Alaska Native (AI/AN) reporting the highest stigma scores. Most of these stigma concerns were related to disclosure, or worries that others will disclose an individual’s HIV status. These respondents said they feel they must be careful about who they tell about their HIV status.

This isn’t dissimilar to the general population of people with HIV, the researchers said.

“This underscores the importance of addressing disclosure concerns when designing interventions to reduce HIV stigma,” they wrote. “Training for providers should focus on actively listening to patient concerns, including stigma experiences, using culturally and linguistically appropriate methods.”

About a quarter of Hispanic people with HIV said they experience healthcare discrimination, with discrimination being more frequently reported by men than women (23 percent and 18 percent reporting, respectively). Black Hispanic people were also more likely to report healthcare discrimination than White Hispanic people, shaking out to 28 versus 21 percent reporting, respectively.

This could be because some people use skin color as a proxy for race, the researchers explained.

“Though not equivalent to racial identity, some Hispanic persons use skin color to select a racial identity category,” they said. “Health care discrimination experienced by Hispanic persons might differ based on skin color, with one study finding that Hispanic persons with darker skin experienced greater health care discrimination than those with lighter skin.”

It wasn’t uncommon for any respondent to say they’ve experienced multiple instances of healthcare discrimination, with 11 percent of them saying they’ve experienced healthcare discrimination three or more times. That’s compared to 8 percent who said they’ve experienced discrimination just once and the 4 percent who said they’ve experienced it twice.

To be clear, any experience of healthcare discrimination is unacceptable.

Most of those who reported healthcare discrimination said they felt like their doctor or nurse was not listening to them, with 62 percent reporting as much. Another 48 percent said they were treated with less respect than others and treated with less courtesy than others.

And while around a third (30 percent) said that discrimination likely stemmed from their HIV diagnosis, a sizeable proportion attributed demographic factors. Around a quarter (23 percent) said discrimination was likely tied to their sexual orientation or sexual practices, while 20 percent linked discrimination to their race or ethnicity.

Stratifying findings about social stigma and discrimination among a population who is HIV-positive is critical for forging a path forward toward health equity, the researchers said. The Hispanic population that is HIV-positive is vast with varying concerns, they added, meaning multichannel approaches will be key to improving overall patient experience.

“Eliminating stigma and discrimination is a national priority and will require person-, provider-, facility-, and community-level interventions,” the researchers said.

Tapping into community-based resources that reflect the cultural, racial, and demographic characteristics of people with HIV will be key.

Supporting cultural competency training in non-community-based settings, like traditional clinics and hospitals or health systems, will likewise be essential.

“Provider-focused trainings, policies, and practices are needed to address HIV stigma and discrimination experienced by Hispanic persons with HIV,” the researchers concluded. “Trauma-informed approaches to HIV care and treatment might reduce discrimination in HIV care settings by creating feelings of safety, empowerment, and trust among patients while moving beyond cultural biases and stereotypes.”